Wednesday, December 20, 2006

Starting with the fall 2007 semester, smoking will be banned everywhere on the campus of Lander University, a public university in Greenwood, South Carolina, including all indoor and outdoor locations, according to a policy recently approved by the Lander Board of Trustees.

The purpose of the policy, according to articles (article 1; article 2) in the Greenville News, is to promote a healthy campus and take a stand on the tobacco issue: "When Lander's tobacco task force did its research about a year ago, university leaders could find no other university or college in the state with a complete ban on smoking indoors and out across the campus, said Lander spokeswoman Charlotte Cabri. Trustees' action came in support of Lander's wellness program, which has been formulated in accordance with the Healthy Campus 2010 guidelines established by the American College Health Association, Lander President Daniel W. Ball said. 'We will have smoking-cessation programs in place to help students, faculty and staff who will be trying to quit smoking,' Ball said. 'We already offer programs on such health issues as exercise, weight control, and stress management. In addition, we pride ourselves on providing a wide selection of healthy foods in our dining hall.' While the decision 'will not be popular with everyone,' Ball said, 'It is important that we as an institution take a stand on this vital health issue.'"

The adoption of this policy seems to indicate a shift in college anti-smoking policies. Previously, the focus was on protecting the university community from secondhand smoke exposure by banning smoking in and around buildings. Now, an increasing number of campuses are considering policies that ban smoking completely on campus grounds.

The Rest of the Story

This policy goes too far.

While it makes sense to ban smoking in college buildings to protect people from secondhand smoke, banning smoking everywhere on campus is not about protecting people from tobacco smoke exposure. Clearly, it is not necessary to ban smoking completely - including all outdoors locations - in order to protect the college community from secondhand smoke. The purpose of such a policy appears, instead, to be to promote health by coercing smokers into not smoking. In other words, rather than protecting the health of people who might be affected by secondhand smoke, this policy is a paternalistic one which aims to protect smokers themselves from their own "poor" decisions.

A second possible purpose of the policy is to set a moral standard for the campus: to send a message that smoking is not a tolerable behavior on the campus.

Neither of these two purposes justifies banning smoking entirely on a college campus.

As I've argued before, the use of coercion to control people's behavior should be reserved for situations in which their behavior is unlawful, poses risks for others, or poses a risk so direct, severe, and immediate that a paternalistic approach is absolutely necessary.

As a public health policy, the Lander University policy is entirely inconsistent. While the university is coercing people into not smoking on campus, they are still free to drink alcohol and to eat as unhealthily as they like. If the university were to be consistent, it would have to ban alcohol use on campus and it would also have to force its dining halls to only serve healthy food.

The president's approach to promoting healthy eating behavior on campus is entirely appropriate: "we pride ourselves on providing a wide selection of healthy foods in our dining hall." In other words, the school provides a choice to students: it makes healthy food available and encourages students to make a healthy choice. That's appropriate.

In contrast, the school takes a different approach with smoking. It does not give students a choice, while encouraging them not to smoke. Instead, it coerces them to not smoke. There is no choice.

The vastly different treatment of different health behavior risks, such as smoking, alcohol use, and a healthy diet, makes the Lander policy inconsistent.

For this reason, it is difficult to accept that the true intention of the proposal is to protect and promote the public's health. If the university had a most sincere interest in protecting and promoting the health of the community, and was willing to use coercion to achieve this interest (which it apparently is), then it would also ban alcohol use and change the dining hall menu so that only healthy food is provided; it would not offer a choice.

To me, therefore, this has the appearance of being more about a moral prescription and a moral statement than anything else. The policy reeks of the second purpose listed above - to set a moral standard for the campus and send a message that smoking is not a tolerable behavior on campus.

The university is singling out smoking as a health behavior decision that is not to be tolerated, while all other unhealthy behavior choices are perfectly acceptable. Why single out one behavior? The answer, in my experience, is that there is something more going on than simply a concern for health promotion. The policy is making a judgment - a moral statement about what behavior choices are acceptable and which choices are not.

At Lander, you can choose to drink excessively and you can choose to eat unhealthy foods, but you cannot choose to smoke. Your choice of behaviors is being dictated to you, and in a completely inconsistent way.

The rest of the story is that the smoke-free movement has changed from a grassroots social movement that sought to protect nonsmokers from secondhand smoke exposure into an institutionalized, moral crusade that aims to send a message that smoking is an intolerable behavior choice.

This policy is not only unjustified and unreasonable, it is also dangerous. What it essentially says is that smokers are not welcome at Lander University. If a similar policy were to be enacted at many colleges and universities, it would essentially mean that kids who smoke would not be able to attend college; or at least, their choices of colleges would be severely limited. Combine this with the growing trend of policies by which smokers are not eligible for employment, and you'll soon have a society where smokers are not eligible for either an education or for employment. We'll be on our way to a two-tiered society, where education and employment is for nonsmokers only.

Isn't it already difficult enough for smokers? Do we need to limit the educational institutions that they can attend as well as the jobs for which they are eligible?

To see how dangerous this policy really is, consider that there is nothing qualitatively different about precluding smokers from attending a particular college than precluding fat people from attending a particular college because the school wants to promote a healthy lifestyle. A school wouldn't necessarily ban fat people from applying to college, but it would require them to lose weight before showing up on campus. Just as smokers aren't disallowed to apply, but they must quit smoking or at least refrain from smoking while on campus (which for resident students seems tantamount to quitting).

Educational institutions, especially public ones, should be open to all who are qualified to attend. Limiting them to nonsmokers or to those who agree to quit smoking is inappropriate.

Lander University: We adhere to an equal opportunity admissions policy, unless you're a smoker. Then, we dictate to you the personal behavior choices that you must make in order to attend our college.

Anti-smoking groups should speak out against this policy and others like it, making it clear that this is not what the smoke-free movement is all about. (Yeah right - like that will ever happen!)

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.